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Lymphoma Occurring During Pregnancy: Current Diagnostic and Therapeutic Approaches

  • Lymphomas (MR Smith, Section Editor)
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Abstract

Purpose of Review

Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and fetal risks associated with treatment or delayed intervention. Herein, we review the current literature for the diagnosis, management, and supportive care strategies for PAL.

Recent Findings

Establishment of a multidisciplinary team, including hematology-oncology, maternal-fetal medicine, and neonatology, is critical in the management of PAL. For staging, ultrasound and MRI are preferred modalities with use of computerized tomography in select situations. Data for the safety and effectiveness of therapy for PAL is largely based on retrospective studies. The timing of lymphoma-directed antenatal systemic therapy depends on the trimester, gestational age, lymphoma subtype and aggressiveness, and patient wishes. Therapy in the first trimester is usually not advocated, while treatment in the second and third trimesters appears to result in similar outcomes for PAL compared with non-pregnant patients with lymphoma. An overarching goal in most PAL cases should be to plan for delivery at term (i.e., gestational age > 37 weeks). For supportive care, most antiemetics, including agents such as neurokinin-1 receptor antagonists, have been used safely during pregnancy. For prevention or treatment of infections, particular antibiotics (i.e., macrolides, cephalosporins, penicillins, metronidazole), antivirals (i.e., acyclovir, valacyclovir, famciclovir), and antifungals (amphotericin B) have demonstrated safety and with use of growth factors reserved for treatment of neutropenia (vs. primary prophylaxis).

Summary

Therapy for PAL should be individualized with goals of care that balance maternal and fetal well-being, which should include a multidisciplinary care team and overall intent for term delivery in most cases.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Eastwood-Wilshere N, Turner J, Oliveira N, Morton A. Cancer in pregnancy. Asia-Pacific J Clin Oncol. 2019.

  2. • Lishner M, Avivi I, Apperley JF, Dierickx D, Evens AM, Fumagalli M, et al. Hematologic malignancies in pregnancy: management guidelines from an international consensus meeting. J Clin Oncol. 2016;34(5):501–8. Expert consensus guidelines for management of hematologic malignancies in pregnancy focusing on optimal treatment of the mother, while protecting fetal and pediatric health.

  3. Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(4):279–87.

    PubMed  Google Scholar 

  4. • Calsteren KV, Heyns L, Smet FD, Eycken LV, Gziri MM, Gemert WV, et al. Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. 2010. Comparison of obstetrical and neonatal outcomes of chemotherapy exposed patients versus unexposed patients diagnosed with invasive cancer during pregnancy, collected over a span of 20 years.

  5. Cottreau CM, Dashevsky I, Andrade SE, Li D-K, Nekhlyudov L, Raebel MA, et al. Pregnancy-associated cancer: a US population-based study. J Women's Health. 2019;28(2):250–7.

  6. Howdeshell KL, Shelby MD. Epidemiology of cancer in pregnancy. managing cancer during pregnancy: Springer; 2016. p. 3–16.

  7. El-Messidi A, Patenaude V, Abenhaim HA. Incidence and outcomes of women with non-Hodgkin’s lymphoma in pregnancy: a population-based study on 7.9 million births. J Obstet Gynaecol Res. 2015;41(4):582–9.

    PubMed  Google Scholar 

  8. Horowitz NA, Benyamini N, Wohlfart K, Brenner B, Avivi I. Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review. Lancet Oncol. 2013;14(7):e275–82.

    PubMed  Google Scholar 

  9. Wang PI, Chong ST, Kielar AZ, Kelly AM, Knoepp UD, Mazza MB, et al. Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. Am J Roentgenol. 2012;198(4):785–92.

  10. Whittaker PG, Macphail S, Lind T. Serial hematologic changes and pregnancy outcome. Obstet Gynecol. 1996;88(1):33–9.

    CAS  PubMed  Google Scholar 

  11. de Haan J, Vandecaveye V, Han SN, Van de Vijver KK, Amant F. Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2016;33:19–32.

    PubMed  Google Scholar 

  12. Brandt JS, Fishman S, Magro CM. Cutaneous melanoma arising from a cesarean delivery skin scar. J Perinatol. 2012;32(10):807–9.

    CAS  PubMed  Google Scholar 

  13. Voulgaris E, Pentheroudakis G, Pavlidis N. Cancer and pregnancy: a comprehensive review. Surg Oncol. 2011;20(4):e175–e85.

    CAS  PubMed  Google Scholar 

  14. Moshe Y, Bentur OS, Lishner M, Avivi I. The management of Hodgkin lymphomas in pregnancies. Eur J Haematol. 2017;99(5):385–91.

    PubMed  Google Scholar 

  15. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005;190(3):467–73.

    PubMed  Google Scholar 

  16. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114(6):1326–31.

    CAS  PubMed  Google Scholar 

  17. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–67.

  18. • Takalkar AM, Khandelwal A, Lokitz S, Lilien DL, Stabin MG. 18F-FDG PET in pregnancy and fetal radiation dose estimates. J Nucl Med. 2011;52(7):1035–40. This study estimated fetal radiation exposure resulting from 18F-FDG PET in pregnant patients and found radiation exposure to be siginificantly below the threshold dose for causing adverse fetal effects.

  19. Jain C. ACOG Committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2019;133(1):186.

    PubMed  Google Scholar 

  20. • Gjelsteen AC, Ching BH, Meyermann MW, Prager DA, Murphy TF, Berkey BD, et al. CT, MRI, PET, PET/CT, and ultrasound in the evaluation of obstetric and gynecologic patients. Surg Clin North Am. 2008;88(2):361–90. ACOG committee practice guidelines for recommendation regarding diagnostic imaging procedures during pregnancy with emphasis on not witholding adequate imaging from a pregnant patient.vii.

  21. Woitek R, Prayer D, Hojreh A, Helbich T. Radiological staging in pregnant patients with cancer. ESMO open. 2016;1(1):e000017.

    PubMed  PubMed Central  Google Scholar 

  22. McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics. 2007;27(4):909–17.

    PubMed  Google Scholar 

  23. Kanal KM, Krupinski E, Berns EA, Geiser WR, Karellas A, Mainiero MB, et al. ACR-AAPM-SIIM practice guideline for determinants of image quality in digital mammography. J Digit Imaging. 2013;26(1):10–25.

  24. • Rimawi BH, Green V, Lindsay M. Fetal implications of diagnostic radiation exposure during pregnancy: evidence-based recommendations. Clin Obstet Gynecol. 2016;59(2):412–8. Review of radation doses associated with fetal risk and radiation doses from radiologic studies and evidenced based recommendations for diagnostic radigraphic studies during pregnancy.

  25. • Germann N, Goffinet F, Goldwasser F. Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients. Ann Oncol. 2004;15(1):146–50. Analysis of 160 patient pregnancies exposed to anthracyclines which determined that the risk of embryo-fetal toxicity is low, especially if exposure is after the first trimester using doses below 70 mg/m2.

  26. van Hasselt J, Allegaert K, Van Calsteren K, Beijnen JH, Schellens JH, Huitema AD. Semiphysiological versus empirical modelling of the population pharmacokinetics of free and total cefazolin during pregnancy. Biomed Res Int. 2014;2014.

  27. • Cardonick EH, Gringlas MB, Hunter K, Greenspan J. Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol. 2015;212(5):658. e1–e8. This study performed developmental testing on children exposed to in utero chemotherapy and found no significant differences in cognitive skills, academic achievement, or behavioral compentence between the exposed and unexposed groups.

  28. • Van Calsteren K, Verbesselt R, Ottevanger N, Halaska M, Heyns L, Van Bree R, et al. Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand. 2010;89(10):1338–45. This study evaluates the impact of physiologic changes of pregnancy on the pharmacokinestics of chemotherapeutic agents between pregnant and nonpregnat state.

  29. Avivi I, Farbstein D, Brenner B, Horowitz NA. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014;28(5):213–20.

    PubMed  Google Scholar 

  30. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5(5):283–91.

    CAS  Google Scholar 

  31. Pentšuk N, van der Laan JW. An interspecies comparison of placental antibody transfer: new insights into developmental toxicity testing of monoclonal antibodies. Birth Defects Res Part B: Dev Reprod Toxicol. 2009;86(4):328–44.

    Google Scholar 

  32. Pinnix CC, Osborne EM, Chihara D, Lai P, Zhou S, Ramirez MM, et al. Maternal and fetal outcomes after therapy for Hodgkin or non-Hodgkin lymphoma diagnosed during pregnancy. JAMA Oncology. 2016;2(8):1065–9.

  33. Aviles A, Neri N, Nambo MJ. Hematological malignancies and pregnancy: treat or no treat during first trimester. Int J Cancer. 2012;131(11):2678–83.

    CAS  PubMed  Google Scholar 

  34. Peccatori FA, Azim H Jr, Orecchia R, Hoekstra H, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl_6):vi160–vi70.

    PubMed  Google Scholar 

  35. • Evens AM, Advani R, Press OW, Lossos IS, Vose JM, Hernandez-Ilizaliturri FJ, et al. Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis. J Clin Oncol. 2013;31(32):4132–9. Largest multicenter study to date of 90 patients with lymphoma diagnosed during pregnancy which found no significant increase in maternal or fetal complications in the women receiving antenatal chemotherapy given as early at 13 weeks of gestation.

  36. Maggen C, Dierickx D, Lugtenburg P, Laenen A, Cardonick E, Smakov R, et al. Obstetric and maternal outcomes in patients diagnosed with Hodgkin lymphoma during pregnancy: a multicentre, retrospective, cohort study. Lancet Haematol. 2019;6(11):e551–e61.

    PubMed  Google Scholar 

  37. Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Armand P, et al. NCCN guidelines insights: Hodgkin lymphoma, version 1.2018. J Natl Compr Cancer Netw. 2018;16(3):245–54.

  38. Connors JM. Advanced-stage Hodgkin lymphoma: new approaches based on novel therapeutic agents or treatment intensification. Cancer J. 2018;24(5):230–6.

    PubMed  Google Scholar 

  39. Dose FR. Adcetris®(brentuximab vedotin). Specialty Drug Utilization Criteria. 2017;14.

  40. Brenner B, Avivi I, Lishner M. Haematological cancers in pregnancy. Lancet. 2012;379(9815):580–7.

    PubMed  Google Scholar 

  41. • Azim HA Jr, Pavlidis N, Peccatori FA. Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part II: hematological tumors. Cancer Treat Rev. 2010;36(2):110–21. Systematic review of women with hematologic malignancies, including lymphoma, that explores the safety of different systemic regimens and proposes alternativves to standardized approaches in the setting of increased risk to the pregnancy and/or fetus.

  42. Eyre TA, Lau IJ, Mackillop L, Collins GP. Management and controversies of classical Hodgkin lymphoma in pregnancy. Br J Haematol. 2015;169(5):613–30.

    PubMed  Google Scholar 

  43. Bachanova V, Connors JM. Hodgkin lymphoma in pregnancy. Curr Hematol Malig Rep. 2013;8(3):211–7.

    PubMed  PubMed Central  Google Scholar 

  44. Avilès A, Nambo M-J, Neri N. Treatment of early stages hodgkin lymphoma during pregnancy. Mediterr J Hematol infect Dis. 2018;10(1).

  45. Abdel-Hady E-S, Hemida RA-H, Gamal A, El-Zafarany M, Toson E, El-Bayoumi MA. Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy. Arch Gynecol Obstet. 2012;286(2):283–6.

    CAS  Google Scholar 

  46. Hay A, Klimm B, Chen B, Goergen H, Shepherd L, Fuchs M, et al. An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma. Ann Oncol. 2013;24(12):3065–9.

  47. Mazonakis M, Varveris H, Fasoulaki M, Damilakis J. Radiotherapy of Hodgkin’s disease in early pregnancy: embryo dose measurements. Radiother Oncol. 2003;66(3):333–9.

    PubMed  Google Scholar 

  48. Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005;6(5):328–33.

    PubMed  Google Scholar 

  49. Woo SY, Fuller LM, Cundiff JH, Bondy ML, Hagemeister FB, McLaughlin P, et al. Radiotherapy during pregnancy for clinical stages IA–IIA Hodgkin’s disease. Int J Radiat Oncol Biol Phys. 1992;23(2):407–12.

    CAS  PubMed  Google Scholar 

  50. Cousins C. Medical radiation and pregnancy. Health Physics 2008;95(5).

  51. Woussen S, Lopez-Rendon X, Vanbeckevoort D, Bosmans H, Oyen R, Zanca F. Clinical indications and radiation doses to the conceptus associated with CT imaging in pregnancy: a retrospective study. Eur Radiol. 2016;26(4):979–85.

    CAS  PubMed  Google Scholar 

  52. Lishner M, Zemlickis D, Degendorfer P, Panzarella T, Sutcliffe S, Koren G. Maternal and foetal outcome following Hodgkin’s disease in pregnancy. Br J Cancer. 1992;65(1):114–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Pereg D, Koren G, Lishner M. The treatment of Hodgkin’s and non-Hodgkin’s lymphoma in pregnancy. Haematologica. 2007;92(9):1230–7.

    PubMed  Google Scholar 

  54. Lavi N, Horowitz NA, Brenner B. An update on the management of hematologic malignancies in pregnancy. Womens Health (Lond). 2014;10(3):255–66.

    CAS  Google Scholar 

  55. Odelia A, Erel J, Chava P, Yair H, Nadav S, Michael L, et al. Continuing dilemmas in the management of lymphoma during pregnancy: review of a 10-point case-based questionnaire. Int J Clin Oncol. 2017;22(1):190–9.

  56. • Avilés A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clinical Lymphoma. 2001;2(3):173–7. Acute and late side effects were evaluated in 84 children whose mothers received chemoterahyp during pregnancy, including 38 during the first trimester over a median of 18.7 years, and no increased risk of adverse pediatric outcomes, including secondary malignancies.

  57. Rizack T, Mega A, Legare R, Castillo J. Management of hematological malignancies during pregnancy. Am J Hematol. 2009;84(12):830–41.

    PubMed  Google Scholar 

  58. Cohen JB, Blum KA. Evaluation and management of lymphoma and leukemia in pregnancy. Clin Obstet Gynecol. 2011;54(4):556–66.

    PubMed  Google Scholar 

  59. Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood. 2011;117(5):1499–506.

    CAS  PubMed  Google Scholar 

  60. Tageja N. Bendamustine: safety and efficacy in the management of indolent non-Hodgkin’s lymphoma. Clin Med Insights Oncol. 2011;5:145–56.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Rummel MJ, Niederle N, Maschmeyer G, Banat GA, von Grunhagen U, Losem C, et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet. 2013;381(9873):1203–10.

    CAS  PubMed  Google Scholar 

  62. Leslie KK, Koil C, Rayburn WF. Chemotherapeutic drugs in pregnancy. Obstet Gynecol Clin N Am. 2005;32(4):627–40.

    Google Scholar 

  63. Das G, Damotte V, Gelfand JM, Bevan C, Cree BA, Do L, et al. Rituximab before and during pregnancy: a systematic review, and a case series in MS and NMOSD. Neurol-Neuroimmunol Neuroinflammation. 2018;5(3):e453.

    Google Scholar 

  64. Jacobson C, LaCasce A. How I treat Burkitt lymphoma in adults. Blood. 2014;124(19):2913–20.

    CAS  PubMed  Google Scholar 

  65. Zagalo C, Pierdomenico F, Cabecadas J, David SP. Burkitt’s lymphoma in a pregnant woman: case report and review of the literature. Case Rep Oncol Med. 2013;2013:370179.

    PubMed  PubMed Central  Google Scholar 

  66. Lam MS. Treatment of Burkitt’s lymphoma during pregnancy. Ann Pharmacother. 2006;40(11):2048–52.

    CAS  PubMed  Google Scholar 

  67. Peterson C, Lester DR Jr, Sanger W. Burkitt’s lymphoma in early pregnancy. J Clin Oncol. 2010;28(9):e136–8.

    CAS  PubMed  Google Scholar 

  68. Lloyd M, Carr M, McElhatton P, Hall G, Hughes R. The effects of methotrexate on pregnancy, fertility and lactation. Qjm. 1999;92(10):551–63.

    CAS  PubMed  Google Scholar 

  69. Warkany J. Aminopterin and methotrexate: folic acid deficiency. Teratology. 1978;17(3):353–7.

    CAS  PubMed  Google Scholar 

  70. Hyoun SC, Obican SG, Scialli AR. Teratogen update: methotrexate. Birth Defects Res A Clin Mol Teratol. 2012;94(4):187–207.

    CAS  PubMed  Google Scholar 

  71. Dawson AL, Riehle-Colarusso T, Reefhuis J, Arena JF, National Birth Defects Prevention S. Maternal exposure to methotrexate and birth defects: a population-based study. Am J Med Genet A. 2014;164A(9):2212–6.

    PubMed  Google Scholar 

  72. Koren G. Treating the mother, protecting the unborn: the motherisk approach. J Pediatr Pharmacol Ther. 2013;18(1):4–7.

    PubMed  PubMed Central  Google Scholar 

  73. Lloyd M, McElhatton P, Carr M, Hall G, Hughes R. Methotrexate in pregnancy. Rheumatology (Oxford). 2005;44(5):697 author reply 8.

    CAS  Google Scholar 

  74. Pinnix CC, Andraos TY, Milgrom S, Fanale MA. The management of lymphoma in the setting of pregnancy. Curr Hematol Malig Rep. 2017;12(3):251–6.

    PubMed  PubMed Central  Google Scholar 

  75. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG Int J Obstet Gynaecol. 2004;111(9):940–3.

    CAS  Google Scholar 

  76. Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013;368(9):814–23.

    CAS  PubMed  Google Scholar 

  77. Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med. 2009;360(24):2528–35.

    CAS  PubMed  Google Scholar 

  78. Asker C, Wikner BN, Källén B. Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol. 2005;61(12):899–906.

    PubMed  Google Scholar 

  79. Rapoport BL, Jordan K, Boice JA, Taylor A, Brown C, Hardwick JS, et al. Aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with a broad range of moderately emetogenic chemotherapies and tumor types: a randomized, double-blind study. Support Care Cancer. 2010;18(4):423–31.

  80. Einarson A, Shuhaiber S, Koren G. Effects of antibacterials on the unborn child. Paediatric Drugs. 2001;3(11):803–16.

    CAS  PubMed  Google Scholar 

  81. American College of O, Gynecologists Committee on Obstetric P. ACOG Committee opinion no. 494: sulfonamides, nitrofurantoin, and risk of birth defects. Obstet Gynecol 2011;117(6):1484–1485.

  82. Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006;107(5):1120–38.

    CAS  PubMed  Google Scholar 

  83. Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. Jama. 2010;304(8):859–66.

    CAS  PubMed  Google Scholar 

  84. Pilmis B, Jullien V, Sobel J, Lecuit M, Lortholary O, Charlier C. Antifungal drugs during pregnancy: an updated review. J Antimicrob Chemother. 2014;70(1):14–22.

    PubMed  Google Scholar 

  85. Dale DC, Cottle TE, Fier CJ, Bolyard AA, Bonilla MA, Boxer LA, et al. Severe chronic neutropenia: treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry. Am J Hematol. 2003;72(2):82–93.

  86. Cardonick E. Pregnancy-associated breast cancer: optimal treatment options. Int J Women's Health. 2014;6:935–43.

    Google Scholar 

  87. Horowitz NA, Lavi N, Nadir Y, Brenner B. Haematological malignancies in pregnancy: an overview with an emphasis on thrombotic risks. Thromb Haemost. 2016;116(10):613–7.

    PubMed  Google Scholar 

  88. Greer IA. Clinical practice. Pregnancy complicated by venous thrombosis. N Engl J Med. 2015;373(6):540–7.

    PubMed  Google Scholar 

  89. Brenner B, Avivi I. Cancer in pregnancy: the role of thromboprophylaxis. Thromb Res. 2012;129:S20–S1.

    CAS  PubMed  Google Scholar 

  90. • Amant F, Van Calsteren K, Halaska MJ, Gziri MM, Hui W, Lagae L, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol. 2012;13(3):256–64. Multicenter observational cohort of 129 children born pregnant women exposed to chemotherapy matched to children of unexposed mothers without cancer, which recorded the health, cardiac function, and neurodevelopmental outcomes of children exposed to in untero chemotherapy.

  91. Shliakhtsitsava K, Romero SA, Dewald SR, Su HI. Pregnancy and child health outcomes in pediatric and young adult leukemia and lymphoma survivors: a systematic review. Leuk Lymphoma. 2018;59(2):381–97.

    PubMed  Google Scholar 

  92. Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson AL, et al. Pregnancy and the risk of relapse in patients diagnosed with Hodgkin lymphoma. J Clin Oncol. 2015;34(4):337–44.

  93. Maltaris T, Seufert R, Fischl F, Schaffrath M, Pollow K, Koelbl H, et al. The effect of cancer treatment on female fertility and strategies for preserving fertility. Eur J Obstet Gynecol Reprod Biol. 2007;130(2):148–55.

  94. Meirow D. Ovarian injury and modern options to preserve fertility in female cancer patients treated with high dose radio-chemotherapy for hemato-oncological neoplasias and other cancers. Leuk Lymphoma. 1999;33(1–2):65–76.

    CAS  PubMed  Google Scholar 

  95. Hodgson DC, Pintilie M, Gitterman L, DeWitt B, Buckley CA, Ahmed S, et al. Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol. 2007;25(1):11–5.

  96. Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al. The impact of cancer on subsequent chance of pregnancy: a population-based analysis. Hum Reprod. 2018;33(7):1281–90.

  97. Behringer K, Mueller H, Goergen H, Thielen I, Eibl AD, Stumpf V, et al. Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol. 2013;31(2):231–9.

  98. Medrano JV, Lujan S, Andres MDM, Pellicer A. Current state regarding fertility cryopreservation in pre-pubertal boys. Rev Int Androl. 2020;18(1):27–34.

    PubMed  Google Scholar 

  99. Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update. 2001;7(6):535–43.

    CAS  PubMed  Google Scholar 

  100. Franchi-Rezgui P, Rousselot P, Espie M, Briere J, Pierre Marolleau J, Gisselbrecht C, et al. Fertility in young women after chemotherapy with alkylating agents for Hodgkin and non-Hodgkin lymphomas. Hematol J. 2003;4(2):116–20.

    CAS  PubMed  Google Scholar 

  101. Howell SJ, Shalet SM. Fertility preservation and management of gonadal failure associated with lymphoma therapy. Curr Oncol Rep. 2002;4(5):443–52.

    PubMed  Google Scholar 

  102. Han SN, Kesic VI, Van Calsteren K, Petkovic S, Amant F, Force ECiPT. Cancer in pregnancy: a survey of current clinical practice. Eur J Obstet Gynecol Reprod Biol. 2013;167(1):18–23.

    PubMed  Google Scholar 

  103. • Amant F, Vandenbroucke T, Verheecke M, Fumagalli M, Halaska MJ, Boere I, et al. Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med. 2015;373(19):1824–34. Multicenter case-control prospective study in which children exposed to in utero chemotherapy were compared with matched children of women without a cancer diagnosis, there was no icnreased impairment in cognitive, cardic, or general development in early childhood. However, iatrogenic prematurity was correlated with a worse cognitive outcome, independent of cancer diagnosis.

  104. Lee EJ, Ahn KH, Hong SC, Lee EH, Park Y, Kim BS. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy for diffuse large B-cell lymphoma in pregnancy may be associated with preterm birth. Obstet Gynecol Sci. 2014;57(6):526–9.

    PubMed  PubMed Central  Google Scholar 

  105. Avilés A, Neri N, Nambo MJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol. 2006;17(2):286–8.

    PubMed  Google Scholar 

  106. Avilès A, Nambo M-J, Huerta-Guzmàn J, Neri N, Cleto S. Speckle-tracking echocardiography to detect cardiac toxicity in children who received anthracyclines during pregnancy. Clin Lymphoma Myeloma Leuk. 2016;16(1):1–4.

    PubMed  Google Scholar 

  107. Committee IP, Kim SS, Donnez J, Barri P, Pellicer A, Patrizio P, et al. Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancer. J Assist Reprod Genet. 2012;29(6):465–8.

    Google Scholar 

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Authors and Affiliations

  1. Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA

    Mansi R. Shah, Kevin A. David & Andrew M. Evens

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Health, 125 Paterson Street, New Brunswick, NJ, 08901, USA

    Justin S. Brandt

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Correspondence to Andrew M. Evens.

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Mansi R. Shah, Justin S. Brandt, and Kevin A. David declare that they have no conflict of interest. Andrew M. Evens: Advisory Board with honorarium: Seattle Genetics, MorphoSys, Mylteni, Karyopharm, and Epizyme; Consultant with honorarium: Novartis, Abvie and Pharmacyclics; Speakers bureau: Research To Practice.

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Shah, M.R., Brandt, J.S., David, K.A. et al. Lymphoma Occurring During Pregnancy: Current Diagnostic and Therapeutic Approaches. Curr Oncol Rep 22, 113 (2020). https://doi.org/10.1007/s11912-020-00972-1

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